CAJ | 학술논문

目的：明确GRACE评分和SYNTAX评分对非ST段抬高急性冠状动脉综合征（NSTE-ACS）远期预后的评估价值。 　　方法：回顾性分析2009-01至2014-01住院诊断为NSTE-ACS的患者共784例，其中单纯药物治疗组410例，支架组325例，CABG组49例。计算患者的GRACE评分和SYNTAX评分，按照评分分为低、中、高危三组。GRACE评分和SYNTAX评分的关系采用Pearson相关分析；生存分析采用Kaplan-Meier法；用Cox比例风险模型进行单因素及多因素分析。计算受试者工作特征（ROC）曲线下面积比较预测方法的优劣性。 　　结果：研究完成随访784例，随访中位时间为47.7个月。Pearson相关分析显示，GRACE评分和SYNTAX评分存在较弱的正相关（r=0.40，P<0.01）；生存分析结果表明，GRACE评分得出的低、中、高危三组的主要不良心血管事件（MACE）发生率逐渐升高（依次为13.81%、23.64%和36.55%，P<0.001）；SYNTAX评分得出的中、高危组的MACE 发生率（分别为39.29%和37.93%）均高于低危组（23.99%），但中危组和高危组之间的差异无统计学意义（P>0.05）。Cox回归和ROC分析显示，GRACE评分和SYNTAX评分对NSTE-ACS的长期预后评估均有重要价值。将GRACE评分、SYNTAX评分及GRACE和SYNTAX联合评分进行ROC曲线分析后发现，三者对NSTE-ACS患者远期MACE风险均有良好的预测价值，但三者的95%可信区间明显重叠，预测价值的差异无统计学意义。 　　结论：GRACE评分和SYNTAX评分存在相关性，二者对NSTE-ACS的远期预后评估均有重要价值，预测价值无明显差异，即使两者联合也并不提高预测价值。利用GRACE评分对NSTE-ACS患者的远期预后进行低、中、高危分层是适宜的。
목적：명학GRACE평분화SYNTAX평분대비ST단태고급성관상동맥종합정（NSTE-ACS）원기예후적평고개치。 　　방법：회고성분석2009-01지2014-01주원진단위NSTE-ACS적환자공784례，기중단순약물치료조410례，지가조325례，CABG조49례。계산환자적GRACE평분화SYNTAX평분，안조평분분위저、중、고위삼조。GRACE평분화SYNTAX평분적관계채용Pearson상관분석；생존분석채용Kaplan-Meier법；용Cox비례풍험모형진행단인소급다인소분석。계산수시자공작특정（ROC）곡선하면적비교예측방법적우렬성。 　　결과：연구완성수방784례，수방중위시간위47.7개월。Pearson상관분석현시，GRACE평분화SYNTAX평분존재교약적정상관（r=0.40，P<0.01）；생존분석결과표명，GRACE평분득출적저、중、고위삼조적주요불양심혈관사건（MACE）발생솔축점승고（의차위13.81%、23.64%화36.55%，P<0.001）；SYNTAX평분득출적중、고위조적MACE 발생솔（분별위39.29%화37.93%）균고우저위조（23.99%），단중위조화고위조지간적차이무통계학의의（P>0.05）。Cox회귀화ROC분석현시，GRACE평분화SYNTAX평분대NSTE-ACS적장기예후평고균유중요개치。장GRACE평분、SYNTAX평분급GRACE화SYNTAX연합평분진행ROC곡선분석후발현，삼자대NSTE-ACS환자원기MACE풍험균유량호적예측개치，단삼자적95%가신구간명현중첩，예측개치적차이무통계학의의。 　　결론：GRACE평분화SYNTAX평분존재상관성，이자대NSTE-ACS적원기예후평고균유중요개치，예측개치무명현차이，즉사량자연합야병불제고예측개치。이용GRACE평분대NSTE-ACS환자적원기예후진행저、중、고위분층시괄의적。
Objective: To clarify the predictive value for long-term prognosis of GRACE score and SYNTAX score in patients with non-ST elevation acute coronary syndrome (NSTE-ACS). Methods: A total of 784 NSTE-ACS patients treated in our hospital from 2009-01 to 2014-01 were retrospectively studied. According to the treatment, the patients were divided into 3 groups: Medication group,n=410, Stent group,n=325 and CABG group,n=49. Based on 2 scoring systems, the patients were divided into another 3 groups: Low risk group, Medium risk group and High-risk group. The relationship between GRACE score and SYNTAX score was studied by Pearson correlation analysis, survival analysis was conducted by Kaplan-Meier method, univariate and multivariate analysis were performed by Cox proportional hazard model, and the area under curve (AUC) of ROC analysis was used to compare two methods. Results: All 784 patients completed the follow-up study at the median of 47.7 months. Pearson correlation analysis showed that there was a weak positive correlation between GRACE score and SYNTAX score (r=0.40,P<0.01). Survival analysis presented that by GRACE score system, the MACE occurrence rates in Low risk group, Medium risk group and High-risk group were elevated accordingly as 13.81%, 23.64% and 36.55% respectively. And by SYNTAX system, MACE occurrence rates in Medium risk group and High-risk group were 39.29% and 37.93%, which were both higher than that in Low risk group (23.99%), while the scores between Medium and High risk groups were similar,P>0.05. Cox proportional hazard model and ROC analysis indicated that GRACE and SYNTAX scores had the important predictive value for lone term prognosis of NSTE-ACS. ROC analysis of GRACE score, SYNTAX score, the combination of GRACE and SYNTAX scores showed that 3 of them all had good predictive value for MACE occurrence, three of 95% CI had signiifcant overlapping without statistic differences. Conclusion: GRACE score and SYNTAX score are related, both of them have important while similar predictive value for long term prognosis in NSTE-ACS patients, the combination of 2 scores cannot increase the predictive value. GRACE score is appropriate for the risk stratiifcation in NSTE-ACS patients.